Basic Information
| Provider Information | |||||||||
| NPI: | 1295995165 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ON LOK DAY SERVICES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1333 BUSH ST | ||||||||
| Address2: | |||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941095611 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4152928888 | ||||||||
| FaxNumber: | 4152928745 | ||||||||
| Practice Location | |||||||||
| Address1: | 225 30TH STREET THIRD FLOOR | ||||||||
| Address2: | |||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941312420 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4155502210 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/13/2008 | ||||||||
| LastUpdateDate: | 06/13/2008 | ||||||||
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| AuthorizedOfficialLastName: | EDMONDSON | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR / CEO | ||||||||
| AuthorizedOfficialTelephone: | 4152928888 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | J.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251B00000X | Y | Agencies | Case Management |
No ID Information.